Length Unstable Pediatric Tibial Shaft Fracture Treated With Cerclage Augmented Elastic Intramedullary Nails: A Novel Technique

Introduction: Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored. Materials and Methods: Review of 2 patients receiving novel cerclage augmented elastic nailing technique. Results: Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations. Discussion: We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.